What makes experienced nurses stay in their position? A qualitative interview study

Organisational-level risk and health-promoting factors within the healthcare sector-a systematic search and review

Introduction

The healthcare sector is globally experiencing increasing demands and workplace interventions on an organisational level is sought to create healthy workplaces. The aim of this study was to provide an overview of Nordic research on the work environment and health of healthcare professionals, with a focus on identifying organisational-level risk and health-promoting factors.

Methods

This systematic search and review was based on an analysis of studies published in peer-reviewed journals between 1 January 2016 and 3 January 2023. The selected studies investigate the relationships between organisational-level risk and health-promoting factors and measures of health and well-being among healthcare professionals during ordinary operations. To increase applicability, this systematic search and review was limited to the Nordic countries as they share the same context with a publicly-funded widely accessible healthcare system. A total of 2,677 articles were initially identified, with 95 original studies meeting the criteria for relevance and quality.

Results

Identified organisational risk and health-promoting factors were categorised into five categories: work schedule distribution, operations design and work methods, ergonomic conditions, working conditions and personnel policies, and the organisation's ethical environment. In addition, two themes across the categories emerged, providing further insight into the implications for practice. The first theme emphasises risk and health-promoting factors in the actions that employers take to fulfil the organisation's goals. The second theme emphasises risk and health-promoting factors in connection with the ability of employees to do their jobs at a level of quality they deem acceptable.

Conclusion

Several organisational-level risk and health-promoting factors were identified, and the results indicate that the actions that employers take to fulfil the health-care organisation's goals and promote the ability of employees to provide high-quality care are important for the health and wellbeing of healthcare employees.

Coping Measures for Hospital Nurses' Turnover: A Qualitative Meta-Aggregation (2018-2023)

AIM

To identify and synthesise the qualitative evidence that is available regarding reducing the turnover of hospital nurses from their own perspectives.

DESIGN

A qualitative systematic review using the meta-aggregation design.

DATA SOURCES

Qualitative studies either in English or in Chinese, dating from 2018 to 2023, were obtained from eight databases, including CINAHL, PubMed, Web of Science, Embase, Ovid, and Chinese National Knowledge Infrastructure (CNKI), Wanfang Database and the China Biomedical Database.

METHODS

Studies were screened using pre-determined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines.

RESULTS

Sixteen papers were included that explored nurses' perspectives on enhancing their retention or reducing staff turnover. We developed three synthesised findings and 12 categories from 64 identified findings, including (1) individual adjustment strategy: professional pride, self-growth and psychological adjustment; (2) social support strategy: constructive workplace relationships, balancing work life and recognition of nursing and (3) organisational change strategy: embracing management and leadership, promote nursing professionalisation, workload management and support, flexible work patterns and opportunities, supporting personal career development and competitive salary.

CONCLUSION

This review provides an in-depth and meaningful understanding of nurses' own perceptions and suggestions for enhancing nursing turnover, which will call for a wide range of measures targeting the individual, social and organisational levels.

IMPLICATIONS FOR NURSING MANAGEMENT

This study contributes important knowledge to help improve hospital nurse's turnover, which can provide evidence to support nurse managers, other stakeholders and policymakers in correspondingly developing effective measures to address nurse turnover.

PATIENT OR PUBLIC CONTRIBUTION

There was no direct contribution from patient or caregiver to this study because the data of this study originated from published papers.

Exploring the Influencing Factors of Experienced Nurses' Retention Behaviour: A Qualitative Study Based on the COM-B Model

AIM

The aim of this study was to explore the factors influencing the retention behaviour of experienced nurses in China, using the capability, opportunity, motivation and behaviour (COM-B) model as a conceptual framework.

DESIGN

A qualitative descriptive study based on the COM-B model.

METHODS

In this qualitative descriptive study, semi-structured interviews were conducted with 22 nurses across 11 cities in the Guangdong-Hong Kong-Macao Great Bay Area of China between March and May 2024. The interviews followed a predefined topic guide derived from the COM-B model. The transcriptions of the interviews were then subjected to deductive thematic analysis.

RESULTS

Eleven key themes emerged, which were embedded in three categories of the COM-B model, including capability (physical and mental health, professional knowledge and skills), motivation (increasing income, sense of fulfilment in nursing work, positive colleague relationships and job stability) and opportunity (management, career development opportunities, work-life balance, prejudice against nursing and workload).

CONCLUSIONS

The study provides new perspectives on factors influencing the retention of experienced nurses in Mainland China, Hong Kong and Macao. The study identified 11 factors that influence nurse retention behaviour, emphasising three distinctive perceptions: the 'iron rice bowl', the concept of filial piety and public prejudice towards nursing in Chinese society, which are unique to China compared to other nations. Additionally, it revealed similarities in nurse retention factors across Mainland China, Hong Kong and Macao.

IMPLICATIONS FOR THE PROFESSION

To strengthen nurse retention, it is essential to develop tailored strategies for experienced nurses. Future research should also take social culture into account to enhance retention efforts.

REPORTING METHOD

This study's reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring Reasons for Satisfaction with Job Assignments Among Travel Nurses

OBJECTIVE

The aim of this study was to explore factors related to a travel nurse completing or extending an assignment or leaving before the end of an assignment.

BACKGROUND

Hospitals use various options for staffing shortages. One option is to contract with travel nurses. The recent increase in travel nurse utilization, coupled with the need to retain permanent staff and see a return on investment, requires an understanding of factors driving travel nurse decision-making.

METHODS

This qualitative research used semistructured interviews and a survey with prepandemic-postpandemic participants that comprised travel nurses from 2 urban academic centers.

RESULTS

Three themes emerged from the interview data: flexibility, support, and conditions.

CONCLUSIONS

Travel nurses report they will stay in an assignment if they feel supported and have flexibility and if the location is desirable. Matching institutional needs with travel nurse experience and assignment expectations can create a mutually beneficial experience for the institution, agency, and the travel nurse.

Examining the experiences of mid-career nurses in hospitals: a phenomenological study

BACKGROUND

The turnover of new and mid-career nurses has been increasing, leading to challenges in recruiting and retaining nursing staff.

OBJECTIVES

Securing and retaining mid-career nurses is crucial for ensuring high-quality care. However, little is known about mid-career nurses' experiences regarding turnover. This study aimed to understand the experiences of mid-career nurses and identify strategies to enable mid-career nurses to maintain long-term employment in health services.

DESIGN

Colaizzi's phenomenological methodology was adopted to illuminate the subjective meaning derived from the work-related challenges of mid-career nurses, leading to turnover. Focus group interviews were conducted to delve into the work challenges faced by mid-career nurses.

METHOD

The participants were 23 mid-career nurses working in one tertiary hospital and six secondary hospitals across three Korean cities, recruited using purposive and snowball sampling. The inclusion criteria entailed a minimum of three years of nursing experience and current employment within a designated department or clinical area within the hospital environment, commonly known as a nursing unit. Such units encompassed a range of clinical settings, including medical-surgical units, intensive care units, and emergency rooms. The interview data were transcribed verbatim, and significant statements were extracted from abstract sentences to derive themes through an analytical process.

RESULTS

Analysis of the work experiences of 23 mid-career nurses in medical institutions yielded 15 themes and 4 theme clusters derived from 353 meaningful statements. These theme collections were identified as 'Difficulties endured as a mid-career nurse', 'Meaningless and regrettable new graduate nurses' education', 'An inexpressibly poor work environment', and 'Systems and policies needed to remain in the hospital'.

CONCLUSIONS

Difficulties faced by mid-career nurses including the establishment of an education and career development system, provisions for guaranteed leave, a diverse and flexible work system, opportunities for effective communication, and engagement with the opinions of mid-career nurses should promptly be addressed.

The Vitruvian nurse and burnout: New materialist approaches to impossible ideals

The Vitruvian Man is a metaphor for the "ideal man" by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the "ideal nurse" (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self-sacrificial language (re)producing self-sacrificing expectations. The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self-sacrifice and exhaustion among nurses.

Retaining employment in the hospital setting: A descriptive phenomenological study of Indonesian nurses' experiences

Background

Losing competent nurses due to turnover can have adverse effects on healthcare administration, service delivery, and organizational dynamics. Frequent staff turnover can hinder optimal nursing practices, but some nurses remain committed. Therefore, understanding factors that foster sustained engagement and retention is crucial to create a retention strategy.

Objective

This study aimed to explore the current experience of Indonesian nurses who retain their jobs in the hospital setting.

Methods

A phenomenological design was employed in this study, with ten nurses selected using purposive sampling. Semi-structured interviews were used to gather data from a private hospital in Batam, Indonesia, between January and March 2022. A conventional content analysis was used to analyze the data.

Results

The participants had an average total work experience of 10.4 years and an average age of 35.6 years, ranging from 28 to 44 years. The majority of the participants were females, held bachelor's degrees, and were married. Three main themes were developed in this study: solid teamwork, adequate compensation, and professional career development.

Conclusion

Retaining experienced nurses in hospitals is influenced by antecedents such as teamwork, pay, and career growth. These findings offer nursing and hospital managers insights into developing policies and strategies to improve hospital nursing retention programs in Indonesia and beyond.

Professional identity, job satisfaction, and intention to stay among clinical nurses during the prolonged COVID-19 pandemic: A mediation analysis

AIM

This study aims to examine the relationship between professional identity and job satisfaction and their impact on intention to stay among clinical nurses in China during the prolonged COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted from April 30 to May 25, 2021, in China. Data were collected using professional identity, job satisfaction, and intention to stay questionnaires from 1425 clinical nurses. A single mediation analysis was utilized to test the interrelationship among the variables, and the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist as a reporting guide.

RESULTS

Nurses indicated a medium level of professional identity, job satisfaction, and intention to stay, with mean scores of 3.85, 3.25, and 3.47, respectively. The professional identity displayed positive indirect effect on nurses' intention to stay through job satisfaction (indirect effect = 0.498, 95% CI [0.439, 0.558]).

CONCLUSION

Cultivating professional identity among nurses can increase their job satisfaction and ultimately enhance the intention to stay in the nursing profession. However, this study also suggests paying more attention to job satisfaction to keep nursing retention. These may be helpful to retain the nursing workforce.

What school nurses strive to achieve for themselves in order to remain in practice: A qualitative study

AIM

This study aims to describe and interpret what it is school nurses strive to achieve for themselves in order to remain in practice.

DESIGN

A qualitative study with a hermeneutic approach.

METHOD

The data were collected by means of in-depth interviews with 15 Norwegian school nurses on two separate occasions and analysed using a phenomenological hermeneutic method.

RESULTS

The analysis resulted in the following themes: (1) trusting your own professional ability, (2) aspiring to appreciation and (3) accomplishing self-care. These themes were reflected in the school nurses' choices and actions and were regarded as an expression of what was of value to them as a nurse. Thus, the nurses' realizing what they strived to achieve for themselves can comprehensively be understood as a good of higher value for their remaining in nursing practice.

The relationship between resilience and intent to stay among Chinese nurses to support Wuhan in managing COVID-19: The serial mediation effect of post-traumatic growth and perceived professional benefits

Aim

To explore the mediating role of post‐traumatic growth and perceived professional benefits between resilience and intent to stay among Chinese nurses to support Wuhan in managing COVID‐19.

Design

A cross‐sectional questionnaire survey.

Methods

In May 2020, the study recruited a convenience sample of 200 Chinese nurses to support Wuhan in managing COVID‐19. A set of self‐rating questionnaires was used to measure resilience, post‐traumatic growth, perceived professional benefits and intent to stay. Structural equation modelling was performed with 5,000 bootstrap samples using AMOS 23.0.

Results

The final model provided a good fit for the data. Resilience had the strongest direct effect on intent to stay. Perceived professional benefits partially mediated the association between resilience and intent to stay. Overall, the serial multiple mediations of post‐traumatic growth and perceived professional benefits in the relationship between resilience and intent to stay was statistically significant.